Local Impact: Improving diabetes care for children in Medicaid

Earlier this fall we looked at how Medicaid beneficiaries adhering to their prescription drug regimens could result in a decline in expensive hospitalizations and emergency room visits, and ultimately lower health care costs. A study co-authored by PhRMA and published in the September 2015 edition of Health Affairs found that increasing the number of Medicaid prescriptions filled by just 1 percent reduces spending on inpatient and outpatient services by approximately 0.20 percent among beneficiaries.

This finding is another important milestone in the expanding body of research demonstrating how adherence to medicine directly saves money on other health costs. In 2012, the Congressional Budget Office (CBO) began recognizing reductions in other medical expenditures associated with increased use of prescription medicines in Medicare.

Today, we begin an ongoing look into some of the specific results of the Health Affairs study and the benefits of increased adherence among patient subpopulations. Our first focus is on children with diabetes. Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage to more than 43 million children, including half of all low-income children in the United States.

The Health Affairs study found that among children, a 1 percent increase in diabetes medication fills was associated with a 0.239 percent decrease in total nondrug costs, 0.708 percent lower inpatient costs and 0.118 percent lower outpatient costs. This translates to fewer doctor visits and hospitalizations for children, which is the best kind of health outcome.

Improving adherence and health outcomes for children with diabetes, particularly those with lower incomes who depend on Medicaid, is critical. According to the Juvenile Diabetes Research Foundation (JDRF), over 200,000 children have Type 1 diabetes and that number will grow to over 600,000 by 2050. Between 2001 and 2009 there was a 21 percent increase in the prevalence of T1D in people under age 20. Advances in diabetes treatments have made managing the disease and living a long, healthy life easier. This new research only further highlights the value of adherence to those treatments and the challenging health care outcomes and costs it can avoid down the road.

As demonstrated by the Health Affairs study, better use of medicines can not only enhance the health of children, it can also save needed resources for the entire system. Watch Local Impactfor our ongoing review of medication adherence in the Medicaid population and learn more about adherence in our Ask About Adherence series here.

Samantha Dougherty Samantha Dougherty is a senior director of policy and research at PhRMA. Her primary role is to develop and manage a broad portfolio of research projects related to the use and value of medicines. She has authored and been involved in numerous academic and non-academic projects that have been published in peer-reviewed journals or presented at scientific conferences. Samantha also serves as a lead subject matter expert on cost savings from use of medicines, evidence related to adherence, productivity and achievement of better outcomes. She received a B.S. in Economics from the University of Maryland College Park and a Ph.D. in Pharmaceutical Health Services Research from the University of Maryland Baltimore.